Outline

Objective: To present the variety of tumors of the brachial plexus (BP) encountered in our practice, and to discuss the results.

Methods: 27 patients were surgically treated for tumors in the BP region (22 intraplexal, 4 extraplexal and 1 combined tumor). Among the 22 intraplexus tumors there were 6 MPNST, 16 neurinomas (2 plexiform neurofibromas and 14 solitary nodules) and one intraneural ganglion of the axillary nerve (besides, the patient had an extraosseous plasmocytic plasmoblastoma in the axilla). Among the extraplexal tumors were 3 lipomas and one metastatic carcinoma. All were surgically treated. Malignant tumors received aggressive radiotherapy after surgery. The follow-up ranges from 8 months to 8 years.

Results: All benign solitary intraplexal lesions (with one exception) could be removed in one sitting under IOM without postoperative deficits. One schwannoma was an intra-extraforaminal dumb-bell tumor. This required a second dorsal spinal approach for complete removal. This patient has persistent paresthesias of the C7 dermatome. There were no relapses in any of these cases. In two patients with plexiform neurofibromas (both NF-2) only the symptomatic nodules were removed. The patients underwent 2 and 3 surgeries respectively as their nodules enlarged over time. Both have remained without deficits. From 6 patients with MPNST, one underwent a radical removal of the whole of his brachial plexus (without reconstruction) and subclavian/axillary vessels (with reconstruction). The other 5 patients were treated according to the surgical principles of treatment of malignant brain tumors -removal of the tumor alone without aiming for tumor free margins, while preserving function. Surprisingly, only one female patient had a relapse, which was again removed following the same principle without resulting deficits. The mean follow-up here is 3 years. No mortality was observed. All patients are still followed. In the exceptional case of a combined extra-intraplexal tumor, the ganglion was completely removed without symptomatic recurrence. The plasmocytic plasmoblastoma was further addressed by chemotherapy. There was no relapse at 8 months.

Conclusions: Most interesting of our observations was the behavior of the MPNST’s in our series. A differentiated approach to patients with tumors of the brachial plexus should certainly be considered. Preservation of function is paramount.